P3.J183: Assessing Providers’ Understanding and Comfort with Pediatric Functional Neurological Disorder, a Foundational Step in Clinical Care Pathway Development

Background: Functional Neurological Disorder (FND) is a multi-network disorder characterized by a broad range of neurological symptoms in the absence of neurological disease or damage. FND can shift symptomatology throughout the disorder course, with different presentations across situations, providers, caregivers, and demands. This variability makes diagnosis and care coordination difficult. Once FND is confirmed, diagnostic education is considered the first line of treatment. A conversation between the provider and patient with thorough, confident, and comprehensive education is imperative for a positive prognosis. On-going conversations with providers continue to reinforce, advance understanding and assist with patient healing.

At a midwestern Children’s hospital, variability in care provided to patients with FND was noticed by multiple providers across several departments. This variability resulted in a call to action to form a taskforce centered on improving efficiency and equity of FND care, with the ultimate goal of creating and implementing a clinical care pathway. Since diagnostic education is central to FND, this study seeks to assess provider understanding, comfort and confidence in delivering the diagnosis of FND.

Methods: To understand providers’ understanding with this diagnosis, a hospital-wide survey was sent prior to pathway implementation. Survey data was de-identified and collected via RedCAP. The survey consists of 9 questions, 3 utilizing a 6-point likert scale (0-5), 3 open ended questions, and 3 demographic questions. Survey questions regarded provider knowledge, confidence, and ability to access multidisciplinary care. Open-ended questions asked about challenges, gaps in knowledge and institutional strengths. Current data collection represents information from completed surveys.

Results: Survey completion (n=38) was performed by providers in multiple hospital departments. The response to each Likert scale question indicates beginner-moderate provider knowledge (2.84), comfort (2.61) and confidence (2.63). Providers voiced challenges including lack of provider specific FND training, poor interdisciplinary collaboration, diagnosis delay, and difficulty accessing outpatient care. Suggestions for institutional improvement include development of education materials for all providers.

Conclusion: For a diagnosis where the prognosis hinges on the provider’s ability to provide thorough education, the results of this survey demonstrate significant knowledge gaps and opportunities for intervention. To address this in the pathway, provider resources were built into the algorithm. This includes a communication best practice guide for inpatient providers to access to support them through the diagnostic conversation with the patient and family. Also, at discharge, an informational letter was created for the child’s pediatrician that provides an overview on FND and subsequent treatment. Future studies are in place to assess the efficiency of these educational tools.